About types of scenes, preparation, communication, teamwork, and the use of vital CRM principles to enhance scene safety, you can read here:
1. No Two Scenes Are Alike
Already when responding to the scene, we may encounter adverse weather conditions and slippery roads. In addition, driving to a scene in heavy traffic is demanding. When we arrive at the scene, the setting with all its circumstances is unique every single time.
In this article, we will work our way through some basics first. In July, we will elucidate what great teamwork executed by members of different professional disciplines entails. Following that, we will turn our attention to mass casualty incidents, hazardous materials and fires, as well as mass shooting incidents and bomb attacks. Let us now launch into this new series step by step.
1.1. Patients´ Homes and Workplaces
The patients´ homes can be anything from a well-kept mansion to a really messy and dirty flat. Even in a normal home, there can be steep and narrow staircases, carpets that may glide along the floor when stepping onto them, or low ceilings.
If we are called to an emergency that has happened at work, we encounter all types of workplaces, including factories with complex and dangerous machinery, places full of noise, dust and dirt, as well as farms on which animals are kept.
1.2. Scenes in the Open Air
Construction Sites
A construction site can be anything from roadwork to a ground on which a large building is being erected. The work can be at any stage towards its completion. All types of building materials, electrical lines and equipment are used. There can be pits, or huge scaffolds.
Motor Vehicle Accidents
Car accidents can happen on any type of road, from small lanes to highly frequented motorways. In addition, they happen day and night and in any weather condition. Any type of vehicle can be involved, including huge lorries which carry hazardous materials. Sometimes, one car has crashed, sometimes, several vehicles have collided.
Emergencies Can Happen Practically Anywhere
An accident or an acute illness can happen at any place you can think of, including the forest, places in the wilderness, on a ski slope, or on the beach. In some cases, dedicated rescue services are needed. In this article, we will focus on the regular emergency medical services, which, in Austria and Germany, include not only ambulances, but also doctor´s cars.
2. What Hazards Threaten Scene Safety?
Every single time we respond to a call, we have to reckon with hazards.
2.1. General Threats to Scene Safety
Blood and Bodily Fluids
Blood and bodily fluids are potentially dangerous, as they may contain pathogens such as hepatitis viruses.
Syringes and Other Sharp Objects
Syringes, which have been used to inject drugs, may also contain pathogens. In addition, they may harm emergency personnel just like other sharp objects, which may lie on any type of surface at the scene.
Weapons
Weapons can include all kinds of objects, such as a broken bottle with sharp edges, but also knives, guns, and explosives. Knives should not be underestimated, because they can easily be hidden in a long sleeve.
2.2. The People Who Are Present at the Scene
Patients and Their Relatives
Patients and their relatives, or bystandes may be upset, uncertain about the entire situation, or seriously shocked. It is our duty to be professional and understanding. If necessary, we call a crisis intervention team.
Violence at the Scene
A momentous threat to scene safety is violence. It can have started before the rescuers arrive. In this case, we must make sure that the scene is secured by law enforcement first. However, violence can all of a sudden occur. We have to be able to observe a scene and everyone who is present carefully. Are there any weapons? Has someone entered the scene? Is there any oversized clothing or suspicious behaviour?
Onlookers
At almost any scene, there are onlookers. Today, many of them use their mobile phones to take pictures or even film everyone and everything without any hesitation. We need to take control of the situation as far as possible. For instance, we ask sensible people to guide other pedestrians away from the scene, or we use large blankets to shield a patient from the onlookers.
2.3. Scene Safety in Homes
In addition to the hazards, which we have already elucidated in subchapter 1, there can be dogs and other animals, a wet floor in front of the shower, or objects that lie around on the floor.
The Source of Carbon Monoxide May Be Unsuspicious at First
When someone has committed suicide using a barbecue in a shed with all windows and the door closed and even sealed with tape, everyone in the team knows that the scene may only be entered when it is properly ventilated. In some homes, the source of carbon monoxide could be a malfunctioning gas powered heater. This is dangerous, because there are no senses in our bodies to detect carbon monoxide, which can be perilous.
2.4. Additional Hazards to Scene Safety at Workplaces
At workplaces, there can be noise and heat. In addition, dust and dirt may cause hazards, not only because they can end up in wounds and result in severe infections later on. Machines with moving parts must be secured before any rescue work can be carried out. In large kitchens, hot ovens and huge chip pans with simmering fat may cause burns.
When an emergency has happened in the stable of a farm, the cattle should be properly chained. Horses should be out of the way when an equestrian has been injured.
2.5. Watching out at Construction Sites
At construction sites, all kinds of building material or rubble can lie on the ground. The ground itself may be uneven. Objects may fall from above at any time. In addition, there can be scaffolds that reach several storeys. When a patient has been injured on such a scaffold, we have to start our rescue right there even if there is a small gap between the building and the scaffold or if it is swaying lightly. The power supply and electrical lines may cause problems, as well.
2.6. Crash Sites Are Still Dangerous After the Collision
At crash sites, there may still be traffic which passes by very closely. This is even more dangerous at night or in poor visibility. Sharp metal parts and glass shards are often strewn around the vehicles or even inside of them. A car, which has crashed into the embankment, can all of a sudden cant further to one side. Petrol and other fluids may leak from it.
Generally speaking, the terrain outside and off the road may be uneven, and everyone must pay close attention, especially when carrying a patient.
3. The Importance of Personal Protective Equipment
Before entering the scene, all necessary parts of the personal protective equipment have to be donned.
3.1. Being Visible Enhances Scene Safety
At crash sites, especially at night and in poor visibility, reflecting clothing increases safety considerably. Out of town and on the motorway in particular, also the jacket with its stripes made from reflecting material of the highest safety category has to be worn.
3.2. Protecting Vulnerable Parts of the Body
Helmets
We wear helmets at crash sites when we have to enter a damaged vehicle. We also wear them at construction sites.
The Boots
Our boots protect our feet from chemicals and hazardous fluids, as well as sharp objects. In addition, they insulate from electric currents. They also stabilise the ankles and include safety caps to protect the toes.
Disposable Gloves, Glasses, and Protective Suits
During all calls, we wear disposable gloves. Protective glasses are worn when blood might spurt from a wound or during intubation. Protective suits have to be donned when a patient, who is suffering from a contagious disease, is treated or transferred from one hospital to another. At some rescue stations, even bullet-proof jackets are provided.
3.3. Other Equipment
Almost every team member carries a strong torch. Carbon monoxide sensors help us to detect even small amounts of this gas, to rescue patients from it immediately and to prevent serious poisoning.
4. Preparation, Communication, and Teamwork Are Required
In this subchapter, we will highlight how preparation, communication, and teamwork help to enhance scene safety using two types of scenes as examples.
4.1. Violence at the Scene
The safety of all team members is absolutely crucial.
Driving to the Scene
As soon as possible, the team members start to discuss all availabe pieces of information. What has happened? If the violent act has already taken place, no healthcare provider should enter the scene before police officers have brought the situation under control. Furthermore, the team members should anticipate and plan carefully. For instance, they should predefine code words and hand signals indicating emerging violence and when to leave the scene immediately.
At the Scene
It is vital to check the scene safety first before assessing the patient. The re-evaluation of safety and the overall situation should be continued.
Concerning violence at the scene, there are four methods to deal with it:
- Do not be there: Never enter a scene in case a violent act has happened and the threat is not eliminated yet.
- Retreat immediately: As soon as one team member notices that an assault is going to happen, leave the scene at once, if necessary, without your equipment.
- De-escalate: You may try to de-escalate whilst preparing to leave.
- Self-defence: In emergency medicine, the practitioners are not allowed to use force. Only self-defence is allowed.
4.2. Anticipation, Communication, and Teamwork at the Crash Site
Each year, health care providers die around the world whilst they are travelling to the scene or working at a crash site.
En Route to the Scene
When a team is on its way to the scene, its members begin immediately to gather all available pieces of information from dispatch and the rescuers, who have already arrived there. They then discuss potential hazards and courses of action.
Maximising Scene Safety at the Crash Site
The door to the patient´s compartment of an ambulance opens to the side which faces the guardrail. Equipment is also taken out of the car on this side. Vehicles are parked in a pattern that enhances safety. This means that they are parked behind the crash site and block the lane on which the collision has occurred. In the last vehicle, no one should be present. Sadly, it happens time and again that drivers notice the accident ahead of them too late and crash into this last vehicle in the row.
There should only be as many rescue vehicles as necessary to minimise the number of persons who have to face the hazards at the scene. The blue lights are usually still flashing when the cars are parked. However, no lights should blind or confuse oncoming drivers.
Several Teams Work Together
The fire fighters stabilise vehicles as necessary and they use heavy tools to gain access to the passenger compartment in case the doors cannot be opened. They extinguish the flames in case of a fire, and they strew sand over the fluids leaking from a car.
They have to coordinate all these works with the emergency physician and the paramedics, who want to help the patients as soon as possible. You can easily imagine that this requires great communication skills. It is not always easy to understand who is going to execute what steps using what type of special equipment. Despite of this, every part in the rescue process has to occur in a synchronised manner.
Meanwhile, the police close the respective lane or road and guide the traffic around the crash site. The police officers also communicate with the healthcare providers concerning the severity of injuries, any fatalities, or to clarify if and when they can talk to the accident victims.
5. The Use of Vital CRM Principles Enhances Scene Safety
Below, we will discuss some of the CRM principles briefly and connect them to the types of scenes which we have highlighted above.
Situational Awareness Comprises Continuous Observation
In order to ensure the safety of all team members and the patient or patients, it is crucial to use all senses and to remain concentrated. A hands-on/hands-off approach can be used when people behave slightly aggressively at a scene: The leading team member primarily assesses and treats the patient and one team member observes the relatives and other people whilst assisting.
Call for Help Early and Let Professionals at the Scene Help
As soon as a team realises that it cannot handle the situation alone it should call for the help it needs. This could be fire fighters to help at a crash site, or the police in case of an escalating conflict. The team members should anticipate such eventualities as early as possible, even en route to the scene.
On a farm, family members and personnel can help to calm down animals and chain them properly. At factories, the employees can, for instance, turn off the power supply to a machine on which an accident has occurred.
Re-evaluate the Scene, Safety, and the Situation Constantly
After the initial assessment, all team members should continue to re-evaluate the scene and speak up if they have noticed any threat.
Decision-Making
In the emergency medical service, teams should make decisions which ensure their own, but also their patients´ safety. No one should try to "be a hero" and carry out procedures that are risky or have never been executed before by the respective team.
6. All About Interdisciplinary Teamwork in July
What does it take to exert splendid teamwork together with teams from other professional disciplines? What can be prepared in advance and what is necessary at the scene? Finding the answers to these questions can make all the difference between a devastating result and a successful resuce operation.
Author: Eva-Maria Schottdorf
Date: June 29th, 2024
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After one year, the articles will be removed from the blog page, updated, augmented and turned into books. You can purchase these directly on the page "A Special CRM Book Series" . The first volume is already waiting there for you.